QUATRO Quality Indicators for Radiotherapy Centres

Overview

This project develops a quantitative framework for assessing quality-improvement maturity in radiotherapy centres using international IAEA QUATRO audit data. The work converts qualitative audit findings into structured quality indicators and a Quality Maturity Index (QMI), enabling comparison across centres, domains, income groups, and time periods.

My role

Major contributor, analyst, and methods developer at the IAEA Division of Human Health. I contributed to the conceptual design of the QMI framework, structured extraction of audit information, development of quality indicators and scoring methodology, data curation, Python-based analysis, visualization, validation, and manuscript drafting.

Methods & tools

The project analyzed 81 full QUATRO audit missions conducted across 48 countries from 2005–2026. Fifty-five quality indicators were mapped into six domains: Human Resources, Infrastructure, Clinical Processes, Safety Culture, Quality Management System, and Dosimetry. Each indicator was scored using a structured protocol and converted into domain scores, which were summed into a 0–30 Quality Maturity Index. Analyses included descriptive statistics, income-group comparisons, internal-consistency testing, dimensionality assessment, sensitivity analysis, and reproducibility assessment.

Key findings

The QMI provided a reproducible framework for benchmarking radiotherapy quality maturity. The index showed good internal consistency, with Cronbach's α = 0.81. Across the audit cohort, quality maturity varied substantially between centres and income groups. Dosimetry had the highest average domain score, while Human Resources and Quality Management were among the weakest domains. Several persistent gaps were identified, including workforce limitations, quality-management weaknesses, and incomplete in-process verification of delivered dose.

Why it matters

This project translates two decades of international radiotherapy audit experience into a structured, data-driven framework for quality improvement. By identifying domain-level strengths and weaknesses, the QMI can support audit-informed benchmarking, capacity-building, and safer expansion of radiotherapy services worldwide.

Related output

Manuscript under revision

Second author · Target journal: Radiotherapy and Oncology (the "Green Journal") · Currently under co-author revision.

Conference presentation

Improving Quality in Radiotherapy: Quantitative Analysis of 22 Years of IAEA QUATRO Audits Through Quality Indicators

Accepted as a poster, IDOS 2026 · October 5–9, 2026 · Third & presenting author · Conference

See all Publications.